Aortic dissections are life threatening conditions that start with a tear in the aorta. Over 70% occur in the ascending aorta and arch. An aortic dissection develops when a small tear in the intima of the vessel allows blood to penetrate between the intima and the media/adventitia of the aorta thereby separating the layers of the aorta. This creates two lumens within the aorta, the false (FL) and the true (TL) lumens. This separation causes entry of the pulse pressure which in turn will cause propagation of the tear until a re-entry point is created equalizing the pressure in the FL and TL. The short and long-term consequences of the dissection can be disastrous. In short term, they can cause strokes, ruptures, and malperfusion to branch vessels with deadly consequences. In fact, the 72 hour mortality for untreated type A dissections is approximately 75%. Long-term consequences include degeneration into chronic dissection, re-dissection, and aneurysm formation. These are all very difficult to treat consequences. The principles of treating dissections today entail a) removing or covering the initial intimal tear and b) an attempt to close the FL by tacking the intima to the rest of the wall of the aorta. Removal/coverage of the site of the tear is done effectively by surgically removing and replacing the area of the tear or to cover the tear with an endograft. However, current techniques to tack the intima and close the FL are ineffective and inadequate. In this document, we disclose inventions for transcatheter treatment of dissections with the principles of covering the tear and tacking the intima as basis.
Additionally, the aortic arch of a patient may have variation in size, dimensions and the like. Use of stent portions for being received within the arch are thus constrained by the variations among different aortic arches.
There are devices clinically used for endovascular repair of ascending aortic aneurysms. Although transcatheter valves are a clinical reality, none in clinical use have been designed with the purpose of endovascular repair of multiple types of ascending aortic aneurysms or dissections. Indeed, a device is needed that can treat different anatomical variations of ascending aortic aneurysms and dissections, create effective proximal and distal seal zones within the aorta, and have a durable valve component, but that also allows for future valve re-interventions. A device is also needed that would allow for treatment of different coronary anatomical variations among the patient population, allow future coronary re-intervention, but that also avoids coronary compression, and enables treatment of possible paravalvular leaks.